Download Screening Project

Abigail Smith
Screening Project
The disease I have chosen is cervical cancer in the 21-29 year old female population in
the Atlanta, Georgia area. Since the focus is on the younger demographic and incudes college
aged women the setting will include campus clinics as well as doctors offices and community
clinics. Worldwide, cervial cancer is the third most common cancer in women. Cervical cancer
usually develops very slowly. It begins as a precancerous condition called dysplasia. Dysplasia
can be detected by a Pap smear and is 100% treatable. It can take years for precancerous changes
to tu into cervical cancer. Almost all cervical cancers are caused by HPV (human papilloma
virus). There are many different types of HPV (National Comprehensive Cancer Network, 2011).
Cervical cancer screening tests begin at the age of 21 and can continue until the age of
65. Screening tests for cervical cancer are done during an annual gynocological exam. Women
who do not visit the gynocologist yearly are at an increased risk of developing cervial cancer
when the early signs are not caught during the exam. The most common screening test to detect
cervial cancer is a Pap smear. The pap smear is able to identify cell changes on the cervix before
they become cancerous. Another screening test used is an HPV test that specifically looks for the
human papilloma virus that can cause these cell changes that lead to cervical cancer (Center for
Disease, 2012).
In the state of Georgia an incident rate of 7.7-8.7 per 100,000 was recorded in the year of
2008. With a death rate of 2.5-2.8 per 100,000 in the year of 2008 (Center for Disease, 2012).
This is the most recent year that data is available. A study conducted to show the accuracy of the
pap test to detect cervical cancer came back with results stating that the pap test is only
moderately accurate and was not able to simultaneously give high sensitivity and specificity. The
results showed a range in sensitivity from 30-87% and a specificity ranging from 86-100%
(Nanda, McCrory, Myers, Bastian, Hasselblad, Hickey & Matchar, 2000). One study in the
Cleveland Clinic Journal of Medicine showed a predictive value positive of 96.3% and a
predictive value negative of 99.5% when using HPV testing to detect cancer. These results show
that HPV testing in place of or coupled with pap testing is strongly supported by cross sectional
studies as well as randomized clinical trials. This study has shown that HPV testing is
significantly more sensitive than pap testing when it comes to early detection of cervical cancer.
This study also shows that the combination of HPV testing with pap testing provides at near
100% clinical sensitivity and a 93% specificity (American Cancer Society, 2010).
The main ethical dilemma surrounding cervical cancer screening today is deciding
whether the current screening method is justified with increased findings of damaging effects to
the patient. The screening programs now tend to lead to an increased amount of distress and
anxiety for the patient before and after the screening is conducted. Inaccurate results can cause
long term distress and anxiety, sometimes for no reason. It has been calculated that each life
saved by cervical cancer screening program costs approximately $600,000. This is a large issue
when considering the costs and benefits of screening programs. It has also been shown that the
only way to screen enough patients for the program to be beneficially is through coercion
(Snadden, 1992). Although cervical screening programs have the potential to save lives at
minimal risk but considerable cost, cervical screening programs remain imperative across the
globe.
For the target population I chose, females 21-29, I would suggest continuing the pap
smear as the primary screening test. This is largely due to the fact that the younger population of
women is less likely to have developed cervical cancer. For women over 30 I would recommend
to couple pap testing with HPV testing as these women are more likely to have cervical cancer
and by using both tests you can rule out false positives and have a better rate of diagnosis. These
tests should continue to be offered at doctors offices and clinics alike. By having this screening at
community clinics it can be insured that the population most at risk, those of lower
socioeconomic status, have the ability to get tested and have a better chance of an early detection.
Increasing participation level is tricky when you are dealing with an uncomfortable matter. The
biggest ally here is education. The more education that is out there for young women about
cervical cancer and how it develops the more likely these young women will grow up getting
regular pap testing. It is also important to educate young women on HPV and how the passing of
HPV can be prevented by practicing safe sex. Many women may not be aware of the fact that
cervical cancer develops from HPV and that HPV is preventable. Public Health needs to urge
women of all ages to get tested every few years to stay healthy. I also think clinics on college
campuses should help make the female population aware of cervical cancer screening. Giving
them the awareness at a young age will help reduce the incident rate of cervical cancer.
References:
American Cancer Society. Cancer Facts & Figures 2010. Atlanta, GA: American Cancer Society;
2010.
Nanda K, McCrory DC, Myers ER, Bastian LA, Hasselblad V, Hickey JD, Matchar DB, 2000.
Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic
abnormalities: a systematic review. Annals of Internal Medicine. 132(10): 810-819.
National Comprehensive Cancer Network. NCCN Practice Guidelines in Oncology: Cervical
Cancer Screening. vol.1; 2011
Centers for Disease Control and Prevention. 2012. Gynocologic Cancers. Retrived October 24,
2012, from http://www.cdc.gov/cancer/cervical/basic_info/screening.htm.
Snadden, D. 1992. Ethical Dilemmas of Cervical Cancer Screening. Can Fam Physician. 38: 331333.